Thank you for all the work that you are doing. Need some help with the following situation

1.Last HIV test was done in last month and report was negative. I had not been in any sexual relationship since 4 months

2. Yesterday, I hired an escort (little bit expensive), there was protected oral sex and protected vaginal sex. But the problem is that during the intercourse the condom broke and once we heard the sound I pulled it out. Then she put on a new condom on me and we continued sex for one time and the condom was intact.

 Could you please help me in assessing my risk of Hiv and other STDs? Also do you recommend PEP in this scenario?

Thanks,

Most escorts -- by which I mean high-cost female sex workers by appointment, as opposed to bar pick-ups, etc -- are believed to be at low risk for HIV and other STDs. Most use condoms regularly, get tested often, and have clients who often are low risk themselves (men like you). So if your partner is typical, the chance she has HIV probably is very low. Also, when a woman has HIV, the transmission risk for each episode of unprotected vaginal sex is around 1 in 2,500 (calculated and published by CDC). In your case, even lower, given the very brief exposure after the condom broke. All things considered, I would put your risk of HIV as near zero; I don't even recommend testing for it. And I certainly would not recommend PEP.

Other STDs could be more likely, but probably not much. For the same reasons, the odds are high your partner has no transmissible bacterial STD (gonorrhea, chlamydia, syphilis) or herpes. HPV is a different story, since everybody is infected at one time or another -- but you can assume you have had HPV yourself, perhaps a few different infections -- and this particular event does not materially increase your risk of having HPV or a future health problem from it (e.g. genital warts).

Assuming this event represents your general sexual lifestyle -- occasional commercial sex with escorts -- and you generally use condoms, I would not recommend testing after most individual exposures. It would make more sense to just plan on regular testing (once a year, maybe, depending on the frequency of such exposures), and not after each exposure. Of course you are free to be tested now if you wish. If you decide to do so, I would recommend a urine gonorrhea/chlamydia test (valid any time more than 4-5 days after exposure) and blood tests for HIV and syphilis, ideally done after about 6 weeks. And generally to avoid "comprehensive" STD testing panels offered by many labs, which include tests that either are unreliable or so infrequent that it's not worth the effort and cost.

HHH, MD

Thank you so much sir for the response. One thing I missed mention in my comment is that I also performed oral sex on her which i think is a no risk event. Would the oral sex part would make any changes to your assessment?

Thanks

Thanks and Regards,

That completes the two follow-up comments and replies included with each question and so concludes this thread. I'm glad the discussion has been helpful. Best wishes and stay safe.